Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation

Kobayashi, Leo; Lindquist, David G.; Jenouri, Ilse M.; Dushay, Kevin M.; Haze, Donna; Sutton, Elizabeth M.; Smith, Jessica L.; Tubbs, Robert J.; Overly, Frank L.; Foggle, John; Dunbar-Viveiros, Jennifer; Jones, Mark S.; Marcotte, Scott T.; Werner, David L.; Cooper, Mary R.; Martin, Peggy B.; Tammaro, Dominick; Jay, Gregory D.

doi:10.1016/j.resuscitation.2010.01.003

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Volume 81, Issue 4 , Pages 463-471, April 2010

Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation☆☆☆

Leo Kobayashi
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
- Corresponding author at: Rhode Island Hospital Medical Simulation Center, Suite 106, CORO-West Building, 1 Hoppin St., Providence, RI 02903, USA. Tel.: +1 401 444 6237; fax: +1 401 444 5456.
David G. Lindquist
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
Ilse M. Jenouri
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
Kevin M. Dushay
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
Donna Haze
- Department of Nursing, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
Elizabeth M. Sutton
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
Jessica L. Smith
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
Robert J. Tubbs
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
Frank L. Overly
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
John Foggle
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
Jennifer Dunbar-Viveiros
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
- Department of Nursing, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
Mark S. Jones
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
Scott T. Marcotte
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
David L. Werner
- School of Nursing, University of Nevada Las Vegas, Bigelow Health Sciences 419, 4505 Maryland Parkway, Box 453018, Las Vegas, NV 89154, USA
Mary R. Cooper
- Lifespan, Suite 2B, Coro Building, 167 Point St., Providence, RI 02903, USA
Peggy B. Martin
- Lifespan, Suite 2B, Coro Building, 167 Point St., Providence, RI 02903, USA
Dominick Tammaro
- Division of Internal Medicine, Department of Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
Gregory D. Jay
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA
- Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA
- Department of Bioengineering, Alpert Medical School of Brown University, Box D, 182 Hope St., Providence, RI 02912, USA

Received 25 June 2009; received in revised form 20 November 2009; accepted 6 January 2010. published online 01 February 2010.

Abstract

Introduction

High-fidelity medical simulation of sudden cardiac arrest (SCA) presents an opportunity for systematic probing of in-hospital resuscitation systems. Investigators developed and implemented the SimCode program to evaluate simulation's ability to generate meaningful data for system safety analysis and determine concordance of observed results with institutional quality data.

Methods

Resuscitation response performance data were collected during in situ SCA simulations on hospital medical floors. SimCode dataset was compared with chart review-based dataset of actual (live) in-hospital resuscitation system performance for SCA events of similar acuity and complexity.

Results

135 hospital personnel participated in nine SimCode resuscitations between 2006 and 2008. Resuscitation teams arrived at 2.5±1.3min (mean±SD) after resuscitation initiation, started bag-valve-mask ventilation by 2.8±0.5min, and completed endotracheal intubations at 11.3±4.0min. CPR was performed within 3.1±2.3min; arrhythmia recognition occurred by 4.9±2.1min, defibrillation at 6.8±2.4min. Chart review data for 168 live in-hospital SCA events during a contemporaneous period were extracted from institutional database. CPR and defibrillation occurred later during SimCodes than reported by chart review, i.e., live: 0.9±2.3min (p<0.01) and 2.1±4.1min (p<0.01), respectively. Chart review noted fewer problems with CPR performance (simulated: 43% proper CPR vs. live: 98%, p<0.01). Potential causes of discrepancies between resuscitation response datasets included sample size and data limitations, simulation fidelity, unmatched SCA scenario pools, and dissimilar determination of SCA response performance by complementary reviewing methodologies.

Conclusion

On-site simulations successfully generated SCA response measurements for comparison with live resuscitation chart review data. Continued research may refine simulation's role in quality initiatives, clarify methodologic discrepancies and improve SCA response.

Keywords: Emergency treatment, Health care quality improvement, Medical emergency team, Microsystem, Research, Resuscitation, Simulation, Sudden cardiac death

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☆ A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.01.003.

☆☆ Aspects of portable and mobile simulation sessions discussed within the article were presented as abstracts at the April 2008 BMJ International Forum on Patient Safety in Healthcare, Paris, France, the October 2008 Research Forum of the American College of Emergency Physicians Scientific Assembly in Chicago, IL, the November 2008 Lifespan Research Celebration, Providence, RI, and the January 2009 International Meeting on Simulation in Healthcare in Orlando, FL.

PII: S0300-9572(10)00021-3

doi:10.1016/j.resuscitation.2010.01.003

« Previous Next »Resuscitation
Volume 81, Issue 4 , Pages 463-471, April 2010

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